North Texans want quality, affordable and seamless care close to home. With more health care choices than ever before, we want to deliver an exceptional consumer experience that improves satisfaction, lowers costs and reduces readmission rates — all things that are essential to fulfilling our Mission, Vision and Values.

Enhancing the Care Experience

For Texas Health, a great consumer experience begins with quality, safe and reliable care each time we interact, either at one of our entities or in the community. It continues with our caregivers communicating clearly, anticipating and responding to consumers’ needs in a timely and compassionate manner, and helping patients navigate any additional services.

Our caregivers are critical to providing an exceptional care experience. We give them extensive tools and training on how to best engage consumers, patients and their families, as well as develop personalized and distinctive care plans. Our care teams also purposefully round to gather real-time information to help reduce anxiety and stress. To solicit feedback on ways we can improve, we gather ongoing input on everything from billing processes to what we can be doing to make every touch point convenient and seamless.

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To achieve top decile performance in consumer experience and earn the trust and lifetime loyalty of the people we serve.
2018 Performance

Our research revealed we can improve ways that consumers access health information and engage with our entities and providers. In response, we spent the year creating ways for them to:

  • Research primary care doctors, schedule appointments and request prescription refills online.
  • Share their medical history and treatment needs once instead of repeating it with every provider they meet. Integrating electronic medical records between Texas Health Physician Group (THPG) providers and our system enabled the sharing of this information.
  • Make appointments before and after work by extending our service hours.
  • Easily identify THPG providers by rebranding their signage and informational materials using names such as Texas Health Family Care.

Also during the year, we made progress on numerous measures we use to gauge our consumer experience and patient satisfaction. These include:

Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey

This national standardized assessment evaluates patients’ perspectives of their hospital experience. Our par goal for HCAHPS was to be at the 75th percentile rank nationally and we ended the year at the 73rd percentile1. Specific scores include:

HCAHPS Performance
Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG CAHPS) Survey

This evaluation measures patients’ perceptions of care that is delivered by a provider, such as a physician, nurse practitioner or physician assistant in an office setting. Texas Health Physicians Group scored as follows:

Additional CAHPS survey scores include:

Ambulatory Surgery CAHPS
Emergency Department CAHPS

Texas Health also deploys a Press Ganey survey, which assesses patient satisfaction with their care experience. In 2018, these patients rated their care as follows:

Rated Care as Very Good

In 2019, we plan to:

  • Improve access to THPG providers by promoting online scheduling and extending hours of care.
  • Improve our responsiveness to patients’ needs using MyChart, an online patient portal.
  • Make the patient registration process more efficient and less complicated for behavioral health services.
  • Solicit real-time patient feedback to confirm their transition home was smooth.
  • Continue to integrate services and improve the consumer experience.

We have an ethical and moral obligation to provide safe and high-quality care to every single person we care for, every single time. Reducing medical errors and variation in care delivery also helps us lower costs, reduce readmissions and save lives.

Being a highly reliable organization is about consistently and safely providing quality care to patients each time they visit any of our hospitals, outpatient facilities, wellness centers or physician offices. To achieve this, we conduct extensive research and literature reviews to identify evidence-based best practices. We also bring in the expertise of our administrators, clinical leaders, employees, as well as safety and quality improvement teams across all facilities. Together, we execute the following strategic initiatives:

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Our goal is zero harm and to deliver quality, coordinated and reliable care systemwide.
Patient Safety

To reduce safety risks, we promote a culture of safety and reliability, and emphasize personal accountability. We also coach clinical teams on the importance of safety vigilance and reporting, and train them to consistently:

  • Use error prevention tools that reinforce adherence to safety practices, consider safety in all they do and speak up when they see unsafe behaviors.
  • Capture safety events and near-misses so we can identify trends and accelerate improvements.
  • Keep conditions sanitary and sterile to prevent health care-associated infections.
  • Conduct morning safety briefings to address all safety concerns.
  • Alert system safety leaders when issues arise to mitigate additional risks and share safe management practices.
  • Communicate with the care team to confirm they receive critical information or results on time.
  • Dispense the correct medications at the right dose at the right time.
  • Confirm the appropriate surgical site and correctly identify patients before any procedure.

To identify where adverse events are occurring and their root causes, we examine data and analytics. We then make necessary refinements or introduce new methods that are proven to be more effective at preventing harm.

Care Design

Reliable Care Blueprinting™ is a care design process involving both physicians and staff. They discuss challenges, collaborate on best practices and then create a standard approach to delivering evidenced-based care for various procedures. We apply the process broadly – from how we take a patient’s vitals to treating sepsis to processing lab specimens. To drive ongoing improvements, we review industry benchmarks, share lessons learned and set aggressive performance goals.

Patient Engagement

We actively listen, observe and communicate with patients and their families to provide better care experiences and health outcomes. Through our intake and discharge process and regular rounding, our care teams engage patients to drive alignment and understanding of their treatment plans. This also helps us identify individuals at risk for poor self-management and readmission based on their health history.

Care Management

According to the American Association of Colleges of Nursing, “strengthening nursing leadership at the point at which care is delivered” reduces readmissions, improves patient satisfaction and safety, drives compliance with core measures and saves money. Texas Health’s team of clinical nurse leaders (CNLs) manages the clinical care given to groups of 12 to 16 patients.

With master’s degrees in nursing, CNLs work with unit managers, physicians, care transition team members and bedside nurses at all wholly owned hospitals to improve care delivery. They do this by providing continuity of care, rounding with physicians at the patient’s bedside and analyzing clinical data to provide optimum acute care coordination. Additionally, they mentor, bring evidence-based practices to the bedside, assist patients with health-decision planning and collaborate with the care transition team to provide patient support upon discharge. This helps to align the entire care team on care plans, a safe discharge and follow-up requirements.

Care Transition

We design care transition plans based on patients’ unique needs, their support systems and network of providers. Prior to discharge, we share patients’ health histories and care plans with other providers to coordinate follow-up care and monitoring. Effectively managing patients’ transitions from hospital to home helps us improve health outcomes, and reduce their length of stay and likelihood of readmission.

Care Navigation

Our patient navigators help people newly diagnosed with a severe or chronic health issue, or who face a long recovery from an injury or illness, from getting overwhelmed. They help patients find and receive health services, coordinate appointments, send medical records, arrange for translators, assist with paperwork and more. After discharge, they also follow-up with patients to confirm they are receiving the care and attention they need.

Infection Prevention

The team of infection preventionists, medical staff physicians, and staff help protect patients, employees and other caregivers from health care-associated infections. From handwashing, requiring masks, gloves or gowns, and ensuring sanitary equipment and tools, they put infection-prevention processes in place and monitor enforcement.

2018 Performance

Texas Health has deployed more than 35 care modules to improve safety and quality in the last two years. These have helped reduce patients’ average length of stay from 4.76 days in 2017 to 4.3 days.

The Joint Commission surveyed our system in 2018 to assess quality and safety measures as part of its three-year accreditation process and reaccredited 100 percent of our hospitals, including joint ventures. Findings showed significant improvements since the 2015 evaluation, and we had fewer issues than national benchmarks. Surveyors also praised our infection control processes as being some of the best they had seen.

Also during the year, Texas Health:

  • Trained more than 1,000 leaders and reliability coaches in a peer-to-peer approach that provides real-time affirmation and redirection when using error prevention tools.
  • Experienced a 20 percent increase in the reporting of near-misses, which allows us to investigate and eliminate potential risks before they occur.
  • Improved screening for communicable diseases upon patient admission to reduce possible transmission to staff, visitors and other patients.
  • Created a systemwide infection reduction plan and associated strategies. This helped us reduce Clostridium difficile, a bacterial infection, by more than 23 percent.
  • Deployed central line and urinary catheter maintenance checklists to verify these devices are properly maintained and removed as soon as possible. By year-end, we had reduced catheter-associated urinary tract infections by 21 percent and central-line-associated bloodstream infections by 28 percent.
  • Facilitated the rollout of a patient safety event classification system that allows us to cross-check how safety events are classified and track the effectiveness of efforts to improve reliability in patient safety performance.
All-cause readmission rate (omissions: errors threshold)1.060.95
Overall mortality observed/expected1.00.76
Central-line-associated bloodstream infections (CLABSIs)0.800.54
Catheter-associated urinary tract infections (CAUTIs)1.001.03
Sepsis mortality observed/expected0.850.86
Excess days observed/expected1.4471.467 rates the quality of patient care at Medicare-certified hospitals on its Hospital Compare site. You can review the performance of applicable Texas Health entities here. More data can be found in our Quality & Safety Report.

In 2019, Texas Health will focus on reducing surgical site infections after colon procedures and hysterectomies. Texas Health retained an infectious disease physician to champion this initiative and will collaborate with surgeons and anesthesiologists to achieve improved performance.

Addressing the whole person, including physical, mental and emotional health, is essential to improving quality of life, driving positive health outcomes and lowering health care costs. Yet North Texans are not getting the behavioral health support they need. A report from the North Texas Community Health Collaborative revealed that seven North Texas counties had no psychiatric beds at all, and most had fewer behavioral health providers than the national average.

How Texas Health is Responding

Texas Health Behavioral Health provides access to behavioral health services in five inpatient, one residential treatment center and 16 outpatient settings across the Dallas-Fort Worth area. We offer behavioral health services for people affected by substance use disorders and mental illness. As a part of our free screening and referral services, we provide referrals inside our system or to external providers based on clinical need. Our assessment team also connects individuals with community providers that provide services using block grants and state funds.

As a member of the North Texas Community Health Collaborative, which represents 10 area hospital systems, behavioral health authorities and community-based organizations that want to improve behavioral health, we also pursue grants and jointly implement programs that address behavioral health issues.

2018 Performance

Texas Health opened units specializing in the care of women and adolescents affected by substance use disorders during the year. We also invested $11 million in improving safety and the environment of care of our inpatient units to reduce suicide risk.

In 2019, we plan to expand services for those struggling with substance use, including delivering outpatient care for individuals managing opioid use disorders. We also will assess expanding outpatient psychiatric services to see that individuals have access to the entire continuum of care for behavioral health needs. A large portion of grants awarded through Texas Health Community Impact also will help address behavioral health issues.

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Expand access to effective treatment interventions across the continuum of care to improve the lives of North Texans affected by behavioral health conditions.

Diabetes affects the health of more than 2.8 million North Texans, according to the American Diabetes Association (ADA). If left uncontrolled, it can lead to heart disease or stroke, diminish the quality of life and higher health care costs. With a growing population and shortage of diabetes wellness centers, Texas Health is taking steps to help citizens avoid this chronic disease and reduce its impacts.

Services and Support

Texas Health helps those with Type 1, Type 2 or gestational diabetes manage it with education, medication and support. After assessing the extent of support each person needs, we customize management programs to address them. Some patients qualify for 10 hours of in-person diabetes education and coaching while others may benefit from nutrition therapy. We provide care both in our hospitals as well as in 10 ADA-certified outpatient centers. Our diabetes educators, registered nurses and registered dietitians help participants develop diabetes self-management skills to live a healthier life. Each year, we meet with former patients, community leaders and other stakeholders to discuss program goals and services so that we can continually improve.

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Increase consumer awareness of the diabetes education and support available at Texas Health.
2018 Performance

On average, our diabetes educators collectively see 20,000 people each year. Many are unaware of the education and services we provide or are unsure who to consult when they are first diagnosed. To help them navigate this process, we increased engagement with both patients and their physicians to place them in the most appropriate programs based on their needs, ability to pay and access to care. Also during the year, we:

  • Created an inpatient guide that provides comprehensive resources, tips and instructions for patients to reference at home.
  • Standardized insulin order sets to reduce treatment variations and medication errors.
  • Built a diabetes data repository that will allow us to identify trends and compare treatment effectiveness.
  • Began identifying ways to expand services to people with prediabetes to help them mitigate risks before their issues escalate.

Accredited by the Association for the Accreditation of Human Research Protection Programs, Texas Health Research & Education Institute (THRE) offers affiliated physicians and clinicians, medical research firms and universities a single location to design, test and implement innovative medical technologies, procedures and protocols.

THRE has three standalone facilities equipped with exam rooms, labs, pharmacies, monitoring space and research teams. Research coordinators, nurses, data analysts and statisticians support research trials and innovations, along with developing and executing grants, contracts and budgets. While companies and universities fund their own research projects and any system personnel who may assist, Texas Health underwrites studies that support hospital initiatives conducted by its own physician investigators and clinical teams. An independent Institutional Review Board reviews and approves proposed studies to validate they are appropriate, scientifically sound, and comply with ethical and legal guidelines.

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To conduct medical research that will advance patient care and improve the health and well-being of the people in the communities we serve.
2018 Performance

THRE implemented more than 200 studies and drug trials for cancer, heart disease, stroke and other neurological diseases along with a variety of orthopedic and trauma research. Our nursing and pharmacy staff also assessed facets of health care delivery. The U.S. Food and Drug Administration cleared the first reversal agent for Rivaroxaban (Xarelto) and Apixaban (Eliquis) anticoagulants. THRE was instrumental in conducting research that led to approval of AdexXa, a drug that reverses the anticoagulating effects to help clinicians treat life-threatening bleeds.